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A case of pediatric gallbladder torsion requiring differentiation from acute cholecystitis
Get PDF症例は12歳の女児．5日前から続く腹痛，嘔吐のため近医を受診し，腹部エコーで胆嚢壁の肥厚，周囲の液体貯留を認め，急性胆嚢炎疑いで当院救急外来に紹介となった．受診時，右上腹部痛を認めたが発熱なく，採血でも肝胆道系酵素の上昇はみられなかった．腹部エコーで胆嚢はやや正中に偏位し，胆嚢壁の血流低下，胆嚢頸部の壁肥厚から胆嚢捻転症が疑われた．造影CTを施行したところ胆嚢頸部のねじれがみられ，胆嚢捻転症の診断で高次医療機関へ転院搬送となった．同日施行の緊急腹腔鏡下胆嚢摘出術によって同疾患と確定診断された．胆嚢捻転症は特徴的な所見に乏しく診断が困難とされているが，自験例では腹部エコーと造影CTが診断に有用であった．発熱なく腹部エコーで急性胆嚢炎に非特異的な所見がみられたら，当疾患を疑いさらなる精査が必要である．journal articl
Desfurane anesthesia shifts the circadian rhythm phase depending on the time of day of anesthesia
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
A DNA adductome analysis revealed a reduction in the global level of C5-hydroxymethyl-2′-deoxycytidine in the non-tumoral upper urinary tract mucosa of urothelial carcinoma patients
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Inhalation of 2% hydrogen improves survival rate and attenuates shedding of vascular endothelial glycocalyx in rats with heat stroke
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Glutaraldehyde and uranyl acetate dual fixation combined sputtering /unroofing enables intracellular fatty acids TOF-SIMS imaging with organelle-corresponding subcellular distribution
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Diagnosis of non-immediate hypersensitivity to amoxicillin in children by skin test and drug provocation tests: A retrospective case-series study
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Background: Skin rash often occurs upon oral administration of amoxicillin in children, due to non-immediate hypersensitivity. However, information on delayed hypersensitivity to amoxicillin is scarce. Moreover, the appropriate diagnostic method and actual diagnostic rate of delayed hypersensitivity to amoxicillin among Japanese children are unclear. We conducted intradermal tests (IDTs) and drug provocation tests (DPTs) and retrospectively investigated the proportion of children with a definitive diagnosis of non-immediate hypersensitivity to amoxicillin. We then evaluated the characteristics of patients with a positive allergic workup.
Methods: We enrolled children referred for suspected findings of mild or moderate non-immediate hypersensitivity to amoxicillin between August 2018 and March 2020. If the IDT in the delayed phase was negative, DPT with amoxicillin (60-90 mg/kg/day) was performed for 7 days. Non-immediate hypersensitivity to amoxicillinwas defined when IDT or DPT was positive.We evaluated the potential of the drug-induced lymphocyte stimulation test (DLST) to reveal hypersensitivity to amoxicillin.
Results: This study enrolled 27 children. Fourteen children (52%) had hypersensitivity to amoxicillin, of whom 12 had positive IDTs and two had positive DPTs. No differences in age, sex, history of allergic disease, days from oral use to symptom onset, type of rash at symptom onset, generalized rash, and DLST results were observed between the hypersensitivity and non-hypersensitivity groups.
Conclusions: Examination should be performed for children with mild or moderate reactions because positive cases have no significant features and half of the suspected cases are negative.doctoral thesi